Re: Case Study: The New Director

[Guest guest]

Okay, I'll take a stab at poor Fred and his problems. This situation

always makes me wonder - Who would want this job, anyway?

> Fred is now sitting in his office reviewing the events of the past six

> weeks and his possible actions.

>

> 1. Is the situation resolvable?

Yes.

>

> 2. Is this unexpected after 6 weeks on the job?

No.

>

> 3. What symptoms are present?

Low morale, feeling unappreciated and overworked, frustration, anger,

lack of trust.

>

> 4. What are the real problems here?

Lack of knowledge by staff - what is going on? What is the plan? Lack

of organization - everybody doing some of everything. Lack of a plan for

the department. Lack of manpower.

>

>

> 5. What actions should Fred take with the Staff?

Fred should meet with the staff and share with them that he met with

Jan to discuss a letter they had sent to her, and that he would like to

discuss the items with them and give his point of view and plan for

solving the problems mentioned.

> > The work load is too high for quality treatment.

The workload is too high for at least two reasons: 1) lack of staff;

and 2) distribution of duties. Outpatient therapists can cover a larger

caseload than rehab therapists, for example. Fred should propose a

re-distribution of duties and make hiring new staff an important

priority.

> Things are no better with the new director than they were when the

> position was open.

This is not surprising after 6 weeks. Fred could try setting a time by

which changes *could* be expected, and asking staff to re-evaluate the

situation at that time.

> There is no program development occurring.

A development plan should be created, perhaps by a staff committee or

via a good existing model. A departmental plan is needed, and then

individual staff plans that align with the departmental plan.

> Morale is terrible.

Fred can only acknowledge this at this time, and work on this by

showing people he is committed to identifying and solving the problems.

> The director is not available to staff because he spends too much of

his

> time on unimportant " political " issues.

More interaction with staff and identification of important issues.

Delegation of some items so that staff feel responsible for them may

help. Regular meetings to keep each other informed.

> No new staff has been hired to help.

Number 1 problem - develop and implement a plan immediately.

> When problems are brought to the new director, he " doesn't solve them

for

> us " but says " let's work this through together " . Then he expects the

> staff to solve the problem themselves.

This is probably contributing to the feeling of overwork. Fred needs

feedback from the staff about what to do, but he will need to take

action and make changes himself before staff will buy into the idea of

fixing things themselves. After a year of having to fend for themselves

they really need to see lots of action on Fred's part, and move towards

staff assuming responsibility for problems.

> No one knows how they are performing. No one says thanks.

This should go along with the individual development plans, i.e. an

evaluation system that (eventually) will be related to the development

plan. Fred will need to acknowledge people's work and contributions -

often.

> Rumors are out of control.

When do people have time to gossip? Perhaps this can also be solved by

more frequent meetings and sharing of plans and actions taken.

Development of personal relationships through social activities might

also help (also with morale).

> If things don't get better, a large percentage of the staff will leave

> very soon.

Fred can acknowledge people's frustration and maybe even say he

experiences it himself. He can share his ideas and plans for improving

the situation, discuss timelines, and ask for further suggestions. He

should meet individually with each staff member within a few days of the

group meeting to ascertain individual " gripes " and get a handle on

whether just a few people are creating most of the problems.

>

> 6. What actions should Fred take with Jan?

Hmmmm. This is the toughest one of all. I'm looking forward to

people's suggestions. For now, perhaps Fred should just do what Jan

" suggested " - develop a written plan, with steps to be taken, time,

resources/assistance required, etc. and send it to her - the sooner the

better! On the good side, she didn't have any specific suggestions,

which means that at least Fred doesn't have to disagree with her!

>

>

> 7. What actions should Fred take with the department as a whole?

Departmental plan, hire new staff, set up committees or select staff

to deal with some issues (staff recruitment, evaluation, continuing

education, etc.). Regular meeting schedule with assigned tasks and

accountability. Social events that involve all staff. Perhaps a staff

" retreat " with planning and social activities.

>

>

> 8. Should Fred be treating a full case load at this point? If not, how

> much time should he devote to patient care versus managing the department?

> Will staff lose even more respect for him if he doesn't help with patients?

Fred should probably not carry a full case load - at this point he

needs to be devoting 75% of his time to managing the department. Is

there a way he can reduce people's workload without carrying a full

caseload? Maybe some new evals (screening) or just picking up a portion

of one or two people's caseloads so they can focus on one area? I think

staff will lose respect if he doesn't help at all, but if the managerial

actions and necessities are clear to them, they will see why he had to

reduce his workload.

>

> 9. What will be different in 6 months if Fred is successful in turning

> things around?

Full staff, decreased workload, reorganized caseloads, increased

therapist expertise/knowledge and efficiency, happy staff, Jan a quiet

" higher up " who is barely part of the picture, department with a plan,

Fred can maybe pick up a 50% caseload and start looking at increasing

staff responsibility for solving problems they identify.

This is a great case - I'm really looking forward to hearing people's

responses.

Sandy Curwin

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[Guest guest]

,

Great case study! It's a real challenger. Thanks.

I’m surprised it took six weeks! If I were a therapist in that department, I

would have been in Fred’s office after two weeks asking, no demanding for his

evaluation of the situation and his short term goals.

This department is in crisis. Meaning that the therapist have probably

stepped back to a survival mode of operation. To say to them “lets work out

these problems together” at this point is like telling starving people “let’s

learn to fish.” The staff needs to be “fed” in order to move to higher level

of problem solving. Its Maslow’s basic hierarchy of needs.

After twelve months without direction, this staff needs a leader not a

manager. Nor do they need another therapist to provide “token treatments”.

In the survival mode, a staff becomes fragmented and tends to cope

individually with any operational problems and then only when absolutely

necessary. There is no social accountability to one another so how could

teamwork or problem-solving be a viable solution at this point?

Fred needs to concentrate his efforts to secure resources to make

improvements immediately. Before he can even begin to think about long term

resolution, he needs to address immediate needs so that the current staff can

move to the next level of planning. You can’t be creative problem-solvers if

you are starving.

Fred’s Short term Plan:

1. Secure resources for temporary contract therapy help. Not only will this

help with perceived caseload problems, but hopefully protect referral

patterns, revenues, patient satisfaction levels, remaining staff retention,

and allow flexibility in staffing patterns for participation in future

planning.

2. Listen and respond to staff needs ( not whining until proven). In the

survival mode little changes which occur fast can make a big different in

morale/support and demonstrate a commitment to change. New therapy mats,

paint the breakroom, buy a long wanted piece of equipment all trivial changes

for a healthy department but ones that can make a big difference in the

perception of a staff in crisis.

3. Develop and implement temporary processes to handle day to day operation

frustrations. This will help therapist reserve emotional energy by not having

to continuously make decisions. It will also provide a system of fairness in

caseload distribution, rewards, and communication. This beginning of

organization will facilitate the process of identifying existing staff with

leadership potential as suggestions for improving on these temporary processes

are offered. Also clear direction in expectations facilitates the beginning

of individual accountability to the group and provides the framework for

beginning teamwork.

If leaders are identified, Fred needs to compensate them for their efforts

preferably monetarily but at a minimum verbally.

4. Fred also should consider hiring a consultant. This will allow him to

align himself with the staff as part of their team as well as provide him

objective viewpoints. It may also help his credibility with Jan. (People

always seem to listen better to outside consultants that they pay).

5. Jan’s opinion at this point in not important. It is my opinion that

Fred should not spend alot of time or energy trying to convince Jan that

Physical therapist are of any particular value or status level. If the

department improves and he is a good leader, everyone in the hospital will

notice and the department will achieve organizational influence, respect,

community reputation and market share. This alone will help with recruitment

and retention.

6. Rumors are always present. Clear high personal values that guide Fred’s

decisions like integrety, fairness, and courage will help discount rumors. You

can spend alot of time and energy trying to control them. But remember,

nothing discredits the gossips in the group like humor directed toward the

item of gossip not the person. Just watch Bill and Hillary in action for

pointers.

Ideally, Fred should have negotiated for the resources before he accepted the

position. If not, then he provides the terms for Jan. You want it fixed

timely, then put your money where your mouth is or find another director.

Fred needs to be prepared for some staff leaving but he also needs to be

prepared to take extremely good care of the staff that remains. Nothing

travels as fast in the community like bad news, except word of outstanding

pay, extremely good working conditions and fantanstic benefits.

In six Months

In six months, Fred should be facilitating or coaching self-directed work

teams. Most if not all of the contract therapist should be replaced with hired

staff. These self-directed teams will begin planning the direction of the

department’s growth using data gathered from information systems, i.e.

productivity, patient satisfaction, revenues, performance improvement, etc.

that are designed and implemented in the first six months instead of Fred

treating patients.

Fred’s biggest concerns for the future should be how to facilitate change

through continuous learning which is so essential in today’s managed care

environment. He can do this by helping to facilitate a clear set of values

and vision for the future, using data to make decisions consistent with those

values and constant reevaluation of the department’s progress and direction.

In today’s healthcare market, that is no easy feat.

I’m sure to many of you this may sound idealistic, or just plain nonsense.

But the truth is: been there, done that. By the way, I was one of the staff.

Six years later and wiser,

in Florida

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[Guest guest]

,

You proposed some excellent ideas to Fred's situation. The one thing I

disagree with is your stating that Jan is not important. While you stated

Fred needs to challenge her and tell her to put up or shut up (or find a

new manager), keep in mind she may have done just that with the previous

Director and the problem continued.

If someone came to you for something you did not feel was necessary

(whether you are right or wrong) and challenged you to pay for it or else,

wouldn't that make you feel somewhat antagonistic? I would want some

explanation of why it is necessary, and if all I got was an ultimatum

instead then I would boot them out of my office without thinking twice.

Hence, I would say that while Fred's priority is to work with the staff, he

also will need to spend time with Jan to educate her on the merits of P.T.

After all, the case stated that Fred did not really know why the department

was in the state it was in. Maybe Jan ran off the other Director due to

her assumed poor attitude and stingy ways toward P.T. Maybe that Director

did not take the time to educate. This is becoming more and more important

from my observations as nurses and physicians are taking leadership roles

in hospitals. Many of them, depending on their past work settings or

specialties, know little about P.T. We cannot expect them to have a

revelation and think the world of P.T. No, it is up to us to make them see

the light.

Mark Dwyer

Kansas City, Kansas

mdwyer1@...

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